This is the FAQ for topics relating to low carbohydrate diets. This covers quite a bit of ground including:

Syndrome X
Hyperinsulinism
Hypoglycemia
The "Healthy for Life Diet"
The "Carbohydrate Addict's Diet"
The "Atkins [New] Diet Revolution"
"Protein Power"
and so on...

The FAQ is meant to be an introduction to the concept of low-carbohydrate diets. Since so much is in the media about high-carb, low-fat diets, very little is discussed of low-carb diets. However, this seems to be changing as people are becoming aware that "one-diet fits all" doesn't.

Section 1. What is hyperinsulinism?
Section 2. What is Hypoglycemia?
Section 2a. What is the Glycemic Index?
Section 3. What is Syndrome X?
Section 4. Low Carb Diets
4.1 What is Ketosis?
Section 5. All about CAD
5.1 What is the "Carbihydrate Addict's Diet"?
5.2 What is a trigger?
5.3 How can I tell if I'm addicted to carbohydrates or have hyperinsulinemia?
5.4 How fast will I lose weight?
5.5 Won't I be hungry all the time without snacking?
5.6 It frightens me that there's so much fat in this diet.
5.7 Can I do this diet and be vegetarian?
5.8 Can I do this diet low-fat?
5.9 Is 2 cups of vegetables the maximum?
5.10 How do I deal with questions/comments about CAD from nosy relatives and/or friends?
5.11 What can I eat for breakfast other than eggs?
5.12 Starting out? Watch for these!
Section 6. Protein Power
Section 7. Glossary
Section 8. Bibliography
Section 9. Further Resources (mailing list)

Section 1: What is Hyperinsulism?

(Most of this information is gleaned from the Heller's "Healthy for Life")

When you eat carbohydrates your body produces insulin which carries
the sugar (carbs) out of your blood stream into your cells. A person
who has a hyper response produces too much insulin has this action to the
extreme. They will be left with too little sugar in the blood stream
and too much stored in cells (i.e. fat). This leaves you with two
problems: weight gain and hypoglycemia.

The reasons that the popular high-carbohydrate, low-fat diet
doesn't work for some people is because of this response. Every time you
eat carbohydrates your body produces more insulin. Also, your body
produces insulin based on the carbohydrates you have had in the recent past.
So you may be producing insulin without even eating carbohydrates.

Hyperinsulinism is not a new disease. It was identified more than 30 years
ago but has been largely ignored by the medical community.

Section 2: What is Hypoglycemia?

Hypoglycemia is a condition when you have too little sugar
in your blood to fuel your body. The results can be mildly annoying
to very scary, in extreme conditions it could cause death.

It's important to note the "intense hunger". Quite often people
will find themselves very hungry 1-3 hours after eating a high-carbohydrate
meal, like pasta, bread, or bagels. This is the normal reaction to eating
a concentrated source of carbohydrates without much protein or fat. Some
people even experience carbohydrates making them "un-full". After eating
a satisfying meal and feeling full, a sugary dessert can make you feel
hungry again.

Much of what people blame on their lack of will-power is simply
their bodies physical reaction to the types of foods they eat. When you eat
a diet high in carbohydrates your body prompts you to continue eating that
way.

Often dieticians and doctors prescribe frequent high-carb meals.
For a hyperinsulimic person this is terrible since the continual insulin
releases just make the cycle worse and causes weight-gain. Eventually it
may lead to very serious medical conditions.

Section 2a. What is the Glycemic Index?

It's not necessary to understand the G-index to be successful on the
CAD. But it is very helpful to understanding what the concept of
'triggers' is all about. A high carb food that is absorbed quickly can
cause the blood sugar to spike, hyper-release of insulin and quick
plummet. THAT'S what causes the hunger. In practical use on the CAD,
you learn what triggers you, and you also learn to balance the desserts
of the reward meal with proteins and fats to slow down absorption and
blood sugar spikes.

Section 3. Syndrome X

This is a collection of symptoms including:

1. Inability to lose weight on low fat, low calorie diets

2. High triglyceride levels

3. Low good cholesterol levels

4. Hypoglycemia

5. High blood pressure

This set of conditions has been treated with very positive results on low-
carbohydrate diets.

Section 4. Low Carb Diets

There are a number of diets, some new, some old, that are being
used to control the hyperinsulin response. One of the oldest is
Dr. Atkins who, in the 1970's, wrote a diet book prescribing a very, very
low carbohydrate diet. There were other diets based on low carb, high
protein, such as the "liquid protean" diet. Some people got very ill
on liquid protein (if memory serves) and may have even died. At any
rate it gave all high protein diets a bad name.

Dr.'s Richard and Rachel Heller have published several books
that describe diets which are moderate in carbohydrate intake. "Healthy
for Life" (often abbrev. to HFL) and "The Carbohydrate Addict's Diet"
(abbrev. to CAD) are designed to control the amount of insulin the body
releases. Just to summarize, their diet consists of 2 meals very low
in starchy carbohydrates but rich in low-carbohydrate veggies, protein
and fat.

Dr. Sears has published a book called "Entering The
Zone" which is a diet that is strictly 40/30/30 (carb/fat/protein). He
claims that this particular combination produces very desirable reactions
in the body.

High protein diets can be bad for some people, especially people
with kidney diseases. However there seems to be very little recent research
on whether or not ketosis is bad or not. And if it is bad, is it worse
than being overweight? Many diet gurus of the lowfat persuasion have
been accusing ketosis for all kinds of things such as destroying muscle
tissue, causing kidney disease and more. But so far it looks like that
is just unscientific diet-bashing.

4.1 What is ketosis?

Ketones are chemicals that your body produces as a by product
of combusting fat. You can buy "ketostix" which, when passed through
urine, can tell you whether or not you are in ketosis. Ketosis happens
during fasting, low carbohydrate diets, pregnancy and it can be caused
by diabetes.

On Dr. Atkins diet ketosis is the goal. You use up your store
of glycogen (blood sugar) and then your body permanently goes into fat
burning mode to fuel your bodily functions. See one of Dr. Atkins' books
for more information.

Members of the low carb mailing list have looked for information
on Medline about ketosis. The only information that has been found is
about ketosis and an underlying disease which brings on ketosis (such
as diabetes, starvation and so on). From this many people have assumed
that ketosis is harmful, rather than the disease causing the state.
We don't really know if long-term ketosis caused by a high protein diet
is good, bad or indifferent.

4.2 What is the fat-fast?

You may hear people talking about the fat-fast, which sometimes
get capitalized to FAT FAST simply because it is kind of a difficult and
dramatic thing to do. Think about 30 times before doing this. It takes a
big toll on your energy levels. This was paraphrased from Dr. Atkins's
book "The New Diet Revolution".

The background of Fat Fast:

There was a study done by Frederick Benoit and his associates at
the Oakland Naval Hospital. They compare "the 1000-calorie, 10-gm-
carbohydrate, high-fat diet with fasting in seven men weighing
between 230 and 290 pounds. On the 10-day fast, they lost 21 pounds
on average, but most of that was lean body weight; only 7.5 pounds
was body fat. But on the ketogenic diet, 14 of the 14.5 pounds lost
was body fat." (NDR, p. 61)

Who should do fat fast?

People who are metabolically resistant, meaning people who can't lose
weight on the Induction diet, or a low-fat diet of under 900 calories,
and those who don't even get into a ketosis/lipolysis metabolism under
any circumstances. (NDR, p.183)

What is the Fat Fast diet?

Fat Fast is based on the study by Benoit. It is designed for the
hard core metabolically resistant people. It is not supposed to help
you lose fat fast, but rather to push your metabolism to go into
ketosis (the fat burning mode).

It is a 1000-calorie a day, 90% fat diet. You divide the food into
small portions, and have them at different times of the day.
Dr. Atkins suggested dividing 1000 calories into five 200-calorie
portions, and have it at 7am, 11am, 3pm, 7pm, and before bedtime.
(NDR, p.186-87)

Some suggestions for 200-calorie portions are:

o 2 oz. of sour cream, containing 1 tablespoon of caviar, served
on three or four crisply fried pork rinds.

o 2 deviled egg halves, served not in the whites, but on the pork
rinds or on a thin slice of a soya bread recipe.

o Graham Newbould's Pate for Royalty (2 oz.) served on the soya bread.

o Any other recipe or food choices that fits the 200-calorie and 90% fat
criteria.

When should I do Fat Fast?

It is a good idea to try Fat Fast for two days right after the Induction
diet, just to prove that you don't feel hungry. However, it is not
recommended to continue for over a week because it has not been tested
for long term use. It should be interspersed with the Induction diet or
some other strict level of the Atkins diet to make sure that FMS production
is not suppressed by the interposed carbohydrate. The strategy should be
to lose on the Fat Fast and to use the regular Atkins diet to maintain that
loss. (NDR, p187-88)

Section 5. All about CAD.

This next section comes from the old CAD FAQ. Originally when
the mailing list was started it was primarily about CAD. But people from
Atkins and other low-carb diets showed up and now the FAQ has been
rewritten so that it isn't quite so CAD-centric. However the bulk of
the material written so far is about the Carbohydrate Addict's Diet.

5.1) What is the "The Carbohydrate Addict's Diet"?

The Biological Principles

The "The Carbohydrate Addict's Diet" is a diet to control the amount of
insulin the body releases. The Heller's, authors of "The Carbohydrate
Addict's Diet", say that most overweight people release too much
insulin when they consume carbohydrates. Insulin is responsible for
storing fat in addition to working with glucagon to regulate
blood-sugar. When the body produces too much insulin not only is too
much energy stored as fat, in the carbohydrate addicted person, but it
causes drops in blood sugar which can cause fatigue and symptoms like
shakiness, difficulty concentrating, cold sweats, and intense hunger.

The diet controls insulin production by allowing you to eat your
carbohydrates during one one hour meal each day (reward meal). The
body is primed on how much insulin to release based upon previous
meals. So with two meals of low-carbohydrates and one meal of high
carbohydrates you body is tricked into releasing less insulin.
Therefore you store less fat and have steadier blood sugar levels.
Most people find that for the first time they can lose weight and that
they lose cravings and hunger caused by blood sugar drops.

The Diet Itself

First a comment about the two books written by the Hellers. "The
Carbohydrate Addict's Diet", the first book, clearly lays out the diet
along with lists of vegetables and foods you can eat at your
low-carbohydrate meals. The "Healthy for Life" book, just out as of
3/95, goes about it much differently. It eases you into what is
essentially the "The Carbohydrate Addict's Diet" at the advanced
levels. Many people would rather jump right on in with the "The
Carbohydrate Addict's Diet". It's not difficult to follow. Most of us
are unclear why they changed their strategy. So for the sake of
brevity in the FAQ it is suggested you read both books (see the
bibliography for details) and decide how you'd like to approach it. In
this FAQ the diet from from "The Carbohydrate Addict's Diet" is discussed
but the biological principles outlined in "Healthy for Life" are
discussed.

The diet consists of two "complementary" meals, which are low carbohydrate
meals. Most people choose breakfast and lunch for their complementary
meals. It's a good idea not to change this too often because you may find
your body gets confused and you can end up back on the blood sugar spiral
again.

Complementary meals can consist of any of the low carbohydrate vegetables,
meat, cheese, eggs, and other low carbohydrate dairy products. You must
be very careful in selecting foods for your complementary meals. Be sure
to read labels and only choose foods with 4 grams of carbohydrates or less
per serving (see warning below). You also have to be careful about eating out.
Some tuna salads have bread crumbs or other hidden carbohydrates. Be sure to
ask about how things are prepared. Listen to your body, if you get hungry
or sleepy after eating something chances are you are having a blood sugar
drop and you must have gotten something with more carbohydrates than you
can handle. (See the section on Starting Out).

The "reward" meal is fun. Quite simply you can eat anything you want
(within healthy boundaries -- though admittedly some people go crazy and
still lose weight). The meal may only last 1 hour!!! If you go on too
long your body will produce too much insulin. You should try to eat a
healthy meal with plenty of carbohydrates. This is a good time to eat
potatoes, pasta, bread, all the starchy goodies that you love.

Many of us on the mailing list have found that we can't eat a whole lot
when it comes to dinner. We start out thinking you're going to consume
the entire agricultural product of a small, developing nation, but find
we can only consume a portion that most normal-weight people eat.
Sometimes you even don't have room for dessert! The "satiety switch"
seems to start functioning like it does in other people. (Some,
however, do claim that their "satiety switch" is permanently turned off
and they will always have room for dessert).

WARNING: The 4 grams of carbohydrates does not mean you can eat 1/2 a
cookie or 1/2 an ounce of frozen yogurt. Only consume the foods in
the low carbohydrate lists. It's not actually the number of carbohydrates
but the way they are stored in the food. You'll notice that the
low-carbohydrate vegetables in the list are full of fiber and low in
sugars. This means that they release their sugars, what little they have,
very slowly into your blood stream.

---------------

5.2) What is a trigger?

A trigger is a food, drug, vitamin or biological event that causes you
to increase your insulin production, or causes a drop in blood sugar.
Some triggers are obvious such as a high carbohydrate food eaten at the
wrong time (not during the reward meal). Some triggers are very
subtle: Many drugs, prescription and not, can be triggers. Some are
simply triggers because they are starch based, others stimulate insulin
production in other ways. The best way to take drugs and vitamins is with
your reward meal. If you can't take it then, try taking them with a
complementary meal.

Other triggers are PMS for women, stress, illness and so on. These you
have less control over. Some people report excellent success on controlling
PMS with "Oil of Evening Primrose" or vitamin B supplements. The entire
issue of controlling stress is covered extensively in "Healthy for Life".

If you do find yourself with severe symptoms of low-blood sugar because
of a trigger, you should take 2 ounces of milk to try to get it back
under control, or consider eating a small complementary meal. If at all
possible, don't consume a high carbohydrate food to counteract the problem.
It'll just lead to a worse rebound later on.

5.3.) How can I tell if I am addicted to carbohydrates or have hyperinsulimia
or Profactor-H?

There is a short test in the "The Carbohydrate Addict's Diet" book and
a longer, more comprehensive, test in "Healthy for Life". I tested
"slightly addicted" on the first test and "high-risk" in the "Healthy
for Life" test.

For anyone wondering if the Heller's CarboAddict Diet could help them, just
answer a few of these questions:

1. Tired and/or hungry in the midafternoon?
2. Want more dessert an hour after a big meal with desserts?
3. Does breakfast make it harder to stay on that diet?
4. Is it easier not to eat than to cut down?
5. Have difficulty cutting off those starches?
6. Sweets improve mood?
7. Skip the veggies?
8. Sleepy 'drugged' feeling after a large starchy meal?
9. Hard time going to sleep without a snack?
10. Nocturnal eater?

If you find yourself saying "That's ME!!!!" Then you really should find
out what the carbohydrate addict's diet is all about. I've lost over
100 pounds (and I'm not done yet) and I find this to be the easiest
permanent solution to the weight loss problem.
---------------

5.4.) How fast will I lose weight?

No one can say for sure. Some people seem to slip right out of fat,
usually men. Several people have said to be losing about 1/2 pound per
week. Others lose at 1-2 pounds per week. The Heller's don't like to
see people losing more than 1% of their body weight each week.
---------------

5.5.) Won't I be hungry if I can't snack?

No, you should not be hungry. In fact, if you are eating a high
carbohydrate diet now much of the hunger you experience could be
because your blood sugar levels soar and plummet with each dose of
carbohydrates you take. And with each dose of carbs you produce more
and more insulin causing the hunger to get worse as time goes by.

Some people have had low blood sugar problems on their first few days,
which can definitely cause huge hunger. See the section on Starting
Out.

---------------

5.6.) It frightens me that there is so much fat in this diet.

Many of us came to the "The Carbohydrate Addict's Diet" after
unsuccessfully trying to eat a VLF diet and exercising. Some of us
gained weight after strictly following diets of the sort recommended by
Dr. Dean Ornish, "Eat More. Weigh Less", or John McDougall, MD, "The
McDougall Program". We are told that fat is the cause of heart disease,
cancer, and obesity and it seems like, to the layperson, that every
expert is laying the blame at fat's doorstep.

Yet the Heller's, and the studies cited by the Heller's, in the book
"Healthy for Life" lay the blame on insulin. They say that high fat
consumption does not causes heart disease or high cholesterol but that
over production of insulin, or the bodies resistance to insulin, cause
the body to do the wrong things with the fat you eat. The arguments
are very compelling and certainly should be taken into consideration.
If this is something that concerns you, read their book "Healthy for
Life".

Also, it should be mentioned that it is possible to do the "The
Carbohydrate Addict's Diet" and the HFL diet as a lowfat diet. You do
not have to eat the high fat meats and dairy products. You can select
their lowfat substitutes. Just be sure to check that they didn't
substitute something high in carbohydrates for the original. It should
be less than 4 grams of carbohydrates per serving.

The few anecdotal cholesterol testing reported by people on the mailing
list have shown that total blood cholesterol has gone down, the good
cholesterols have increased and the bad ones have decreased. In both
cases triglycerides had been a problem in the past, but were no longer
in the troublesome range.
---------------

5.7.) Can I do this diet and be a vegetarian?

This question is under construction.

---------------

5.8.) Can I do this diet low-fat?

Yes. You may substitute low fat products for high fat ones. Just be
sure to check the carbohydrate grams listed on the package. Some low
fat products substitute carbohydrate ingredients for fat.
---------------

5.9.) Is 2 cups of vegetables the maximum?

No, it's the minimum you should eat at each meal, breakfast excepted.
The Heller's clarify that in a news letter they published, but it was
confusing in the first book.
---------------

5.10.) How do I deal with questions about CAD from nosy relatives
and/or friends?

There's several schools of thought on the subject. First is, if you
are wishing to avoid conflict with people who have strong opinions
on your diet and feel that you should eat the way THEY want you to eat,
avoidance is the best method.

1. Snow them with medical terminology. Explain you have hyperinsulimia
which requires some modifications to your diet. Leave it at that. If they
continue to question you, make a frightened face and tell them there's a
spider crawling up their neck.

2. Lie, lie, lie! If they offer you a carbohydrate laden food during
a complementary (risk-reducing) meal, tell them "no thanks" and either
offer them no explanation or say, "I just don't want any right now" or
say, "my stomach is feeling a little rough, could I have some of that
for later?" Pretend you are just a picky eater, no one ever questions
picky eaters!

3. Offer explanation-lite: Say that you've decided to change your
eating habits so that you don't eat anything with carbohydrates during
the day, just at night, because they make you sleepy. Don't even allude
to the fact it's also a weightloss diet with a real name.

4. Tell the truth. Some people can handle it with grace and interest.
But realize that not everyone really cares about what diet you are on
so you may risk boring them.
---------------

5.11.) What can I eat for breakfast other than eggs?

Some people have experimented with sauteeing tofu in soy sauce. One
recipe is tofu, sauteed in soy along with some powdered ginger and Thai
curry paste. It is actually quite tasty.

Other people give up on eating breakfast altogether and choose to have
a early lunch then a smaller meal in the late afternoon. Still other
people eat vegetables or have a complementary type of lunch for
breakfast.

Remember that what you eat for breakfast doesn't have to be traditional
breakfast food, it is just a matter of reprogramming your brain.
---------------

5.12.) Starting Out: Watch for these!

A few people have a difficult time starting this diet. Often they will
experience extreme symptoms of hypoglycemia or low blood sugar during
the first 2 days to week. No one on the mailing list is sure why this
is but the collective advice for those folks is to:

- If you are female don't start the diet until after your
period but well before you ovulate. Insulin production seems
to be higher during the "PMS" window and that can make blood
sugar swings very bad.

- If you have a difficult time starting the diet you may want
to follow the beginner's diet in "Healthy for Life" and add
"options" every week until you graduate to the advanced diet.
This is a more gradual shift.

- Be very careful about taking any over-the-counter
medication. It's not mentioned in the books but the
"Carbohydrate Gram Counter" lists things like aspirin,
decongestants and so on as triggers for insulin production.

- Eat plenty of vegetables and fat your first week. The
vegetables have lots of fiber and will keep you feeling full
and help control the blood sugar. Fat will help you feel
full. After a week you can get stricter about eating fat if
you wish.

And here's some Reward Meal advice:

Be kind to yourself. Plan large RMs full of veggies (at least 3 cups)
plenty of protein and plenty, plenty, plenty of carbs for the first few
days. Remember, you want to eat enough to satiate you both
physiologically and psychologically until the next day. You'll find that
the hunger will disappear and you'll naturally cut back on the amount of
food you eat during the RM, but you will always have to have a protein
with any carbos you eat at this time.
---------------

Section 6. Protein Power

Thanks go to Jeanne Dusseault for this section that discusses the program
outlined in the "Protein Power" book by Dr.'s Michael and Mary Dan Eades.

Protein Power is similar to Atkins. So similar in fact it is recommended
highly that everyone on Atkins read it--not necessarily to switch, but to
get the added information. (It will help defend your eating plan, for
those who want more ammo!)

The Protein Power plan is summarized and then there is a description
of how it differs from Atkins.

SUMMARY:
There are two major parts to PP: Intervention and Maintenance. What most
people on this list are concerned with is weight loss and metabolic control
(controlling cholesterol, blood pressure, type II diabetes). This is the
Intervention stage. Intervention has two "phases," aptly named Phase I (for
people who have more than 20% bodyfat to lose or have the afore mentioned
conditions) and Phase II (for people with none of the afore mentioned
conditions and have less than 20% bodyfat to lose).

Phase I: 30g carbs (or less) per day

Phase II: 55g carbs per day (basically the same as Phase I but allows
slightly more carbs)

Minimum protein requirements: there is rather a big deal made of minimum
protein requirements in PP but anyone already on Atkins won't find this to
be a problem achieving.

MAINTENANCE, or your lifetime eating plan:
Once you have reached your ideal bodyfat percentage, or you're within 5% of
your ideal weight, or you've achieved metabolic control and stability, you
move from Phase II to Maintenance. Similar to Atkins, you slowly add carbs
until you stop losing weight (basically). You are aiming for your carbs to
equal your protein (in my case, 66g). Depending on the person, you can
increase your carbs as much as 30% more of your protein (for me this max
would be 86g). When you've taken a "nutritional vacation" (love that
phrase!), return to Phase I for 3 days, or until you've lost the weight,
finish the week on Phase II, return to your regular maintenance.

DIFFERENCES from Atkins:
* You figure out your minimum protein requirement and make sure you get it
(more accurately, you plan your meals around it.)
* Carbs are split fairly equally among meals and snacks (7-10g: 7 if you're
snacking, 10 if you're not)
* No one meal or snack should exceed 12g carbs.
* Discusses good vs. bad fats (ie. butter=good, margarine=bad)
* Aim for 25g minimum fibre per day
* Grams of fiber are subtracted from carbs for an Effective Carb Count or
"ECC." (The theory is that, although fiber is carb, it doesn't metabolize.)
For example, on Phase I your carb intake is 30g ECC--on Atkins that roughly
translates to 55g carbs, but those "extra carbs" and then some are all good
veggie sources.
* Even though Atkins is adamant about avoiding sugar/starch consumption, I
don't believe he emphasizes how important it is to spend your carbs on
good, fibrous veggies.
* Drink till you float (good advice for Atkins too.)
* Dares to mention that evil "E" word: exercise.
* It doesn't dwell on ketosis, but does mention that if you have a lot of
fat to lose, you will be in ketosis and you can monitor that with Ketostix
if you wish.
* A glass of wine with dinner is encouraged (though he doesn't say why
exactly, Atkins is very pro-wine too.)
---------------